Individual
SHELIA KERESA CHILDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
100 GROSS CRESCENT CIR, FORT OGLETHORPE, GA 30742-3643
(706) 858-2161
(865) 560-7387
Mailing address
PO BOX 634909, CINCINNATI, OH 45263-6019
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
003045
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100002328D
—
GA
01
—
P00231570
RAILROAD MEDICARE
GA
01
—
P00231570
BCBS OF TENNESSEE
TN
Enumeration date
07/01/2006
Last updated
01/11/2012
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